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Emergency Response Team

Emergency Response Team. Dr Wong Kin Wa ICU, PYNEH, Hong Kong 29 May 2009. Emergency Response Team. Emergency Response Team. Seriously ill patients and patients at high risk of developing serious illness no longer confined to ICU

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Emergency Response Team

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  1. Emergency Response Team Dr Wong Kin Wa ICU, PYNEH, Hong Kong 29 May 2009

  2. Emergency Response Team

  3. Emergency Response Team • Seriously ill patients and patients at high risk of developing serious illness no longer confined to ICU • High incidence of potentially preventable mortality in General WARDS • A generic , multidisciplinary hospital flexible model for clinical emergency response systems (CERS) • provision of BLS and ALS • providing support for general ward staffs for early recognition of a deteriorating clinical condition

  4. 5 Essential Components of Emergency Response Team • Recognition of worsening condition and appropriate response (ward staff + primary care team) • Protocol for when and how to trigger a response to call for assistance (ward staff+ primary care team) • Responders who are capable to intervene (medical emergency team) • Training system for staffs involved in 1-3 • Quality improvement

  5. Structure of CERS • Individuals trained in resuscitation and early recognition and management of patient in critical conditions • Hospitalists • Career medical officer who is trained in caring for patient with deteriorating condition • Nurse emergency assessment team/ patient at risk team • Nurse educator • ICU/ED outreach nurse • After hour medical team

  6. 4 Levels of Response to Patients with Deteriorating Condition MEWS modified early warning signs

  7. Potential Calling Criteria for MET • Airway: all respiratory distress/ airway obstruction • Breathing: • RR<5/mins • RR>25/mins • Circulation: • Cardiac arrest • Pulse<40/min • Pulse>140/min • SBP<90mmHg • Other potential worrisome criteria • Neurology: • Fall in GCS >2 points • Repeated / extended seizure • SPO2<90% • Urinary output <200ml in 24 hr • BE <-5 • PAO2 <60mmHg

  8. Inside HospitalWards and units(except medical ward and operation theatre) Ward staff activates Arrest Call via operator + started BLS ICU (BLS+ALS) Anesthetist (airway) ward staff and primary care team (BLS and backup)

  9. 死者子轟明愛無人性 醫院堅持職員依足指引沒犯錯 (明報)2008年12月22日 星期一 05:10 • 運輸商前日在貨車上贏馬心臟病發， 兒子即驅車往醫院尋求「希望」，卻換來職員回答謂「唔關我事，你打999」。明愛高層昨日高調回應事件，堅持職員的做法符合醫院指引沒犯錯，「就算我親人在醫院門口心臟病暈低，我都係打999叫白車，醫院門外應該由消防去救」， • 院方：親人門外出事也打999 • 明愛急症室主管吳奎昨聲稱，就算自己的親人在醫院門口心臟病發，也只會打999等救護車。龍仔聞之大怒﹕「我梗係唔信佢啦！你估我傻㗎咩！佢竟然話 喺醫院門口，唔關醫院事！話係消防員嘅責任，識得救人嘅都應該出嚟救呀嘛！嗰個我阿爸嚟㗎！ • 「淨係救醫院範圍裏的人？」 • 「好似唔關佢事，醫院唔係救人㗎！淨係救醫院範圍裏面呀？有人喺門口叫救命呀！叫人去打999，詢問處無電話嘅咩？我好想講，好想表達，好想投訴佢 地…」

  10. HKEC TASK FORCE ON DESIGNATED RESPONSE TEAM GUIDELINES FOR HANDLING PERSONS REQUIRING EMERGENCY MEDICAL ASSISTANCE IN THE VICINITY OF HOSPITALS AND CLINICS (HKEC) VERSION II 25 MARCH 2009

  11. Handling Persons Requiring Emergency Medical Assistance in the Vicinity of HA Hospitals and Clinics

  12. 東 區 醫 院 兩 分 鐘 救 人 【 本 報 訊 】 一 名 退 休 老 牧 師 昨 在 東 區 醫 院 門 外 暈 倒 ， 該 院 急 症 室 醫 護 人 員 兩 分 鐘 已 趕 來 救 援 ， 將 他 救 回 一 命 。 老 牧 師 連 聲 感 謝 東 區 醫 院 醫 護 人 員 ， 並 指 明 愛 醫 院 有 錯 不 認 ， 行 政 總 監 馬 學 章 應 該 辭 職 ， 「 唔 好 要 人 踢 你 至 走 。 」 昨 晨 他 由 妻 子 陪 同 ， 從 北 角 乘 搭 小 巴 往 東 區 醫 院 專 科 門 診 大 樓 覆 診 ， 約 早 上 10 時 ， 小 巴 抵 達 東 院 主 座 大 樓 ， 兩 夫 婦 下 車 後 ， 妻 子 先 往 門 診 大 樓 掛 號 ， 但 她 等 候 多 時 仍 未 見 丈 夫 出 現 ， 向 保 安 員 查 問 時 知 悉 有 人 暈 倒 ， 她 隨 即 趕 往 急 症 室 ， 才 知 丈 夫 出 事 。 事 發 早 上 10 時 09 分 ， 在 主 座 大 樓 對 開 約 10 米 的 行 人 路 上 ， 曾 牧 師 行 往 門 診 大 樓 途 中 ， 疑 血 壓 低 不 適 暈 倒 ， 途 人 見 狀 高 聲 呼 叫 ， 保 安 員 上 前 察 看 及 扶 他 ， 另 有 清 潔 女 工 入 大 堂 通 知 詢 問 處 職 員 。 10 時 11 分 ， 兩 名 急 症 室 醫 生 及 護 士 ， 攜 同 急 救 箱 抵 達 事 發 地 點 ， 替 曾 進 行 急 救 ， 他 當 時 逐 漸 蘇 醒 ， 醫 護 人 員 向 他 詢 問 情 況 及 進 一 步 檢 查 ； 10 時 14 分 ， 曾 牧 師 已 被 抬 上 擔 架 床 送 往 急 症 室 。

  13. Medical Emergency Team: • Team consists of individuals with skills of CPR and management of medical emergencies

  14. Composition of MET • Minimally 2 members, 24 hr service • A medical practitioner with training and experience in critical care • A registered nurse with experience in critical care (ideally from ICU, ED, OT) • P.S. At least 1 member should be trained with skills of team leader

  15. Smooth Operation of MET • Team leader should determine: • Items of equipment to be taken • The source of equipment • Division of labor • Whether individual with skills in intubation, advanced airway manoeuvres would be needed

  16. Financial Budget of CERS Annual budget for maintenance of: • Training of staff in BLS, ALS • Training of MET members • Training of ward staff in recognition and management of deterioration of patients’ condition • Equipment • Extra medical and nursing staff for providing CERS service

  17. Liverpool hospitals experience

  18. Training • Training and annual re-assessment in BLS of all clinical staffs • Training and annual re-assessment in ALS of all clinical staffs in acute care (ICU, CCU, HDU,ED) • A system for facilitation of attendance of staff • For recognition and management of patient with warning signs, e.g.: • ALERT course in UK, RAMPAC (Recognition and management of acute condition) course at Sydney • Display CERS call and response algorithm in all patient care area and intranet

  19. Training • Training for leader in leadership and team work • Rotation of junior staff to critical care unit • Multidisciplinary ward rounds to promote network and communication • M+M meeting for sharing and inadequacies highlight and prevent repetitive mistakes • Identified training centre for staff

  20. Quality control • CERS coordinator or committee for audit of operation: • Review operations of CERS and appropriate response • Follow up of incidents in CERS • Review of training course at at least 1-3 months interval • Database for calls for MET, critical incidents in operation of CERS, current status of staff’s assessment in BLS,ALS • Statewide expert bodies should monitor progress of CERS and compliance with the recommendation

  21. Quality control • Ensure supply of resource for operation, monitoring and training • Conduct of studies for identifying patient with deterioration conditions, e.g. joint ward round with multiple specialties, e.g. orthopedic surgeons and geriatricians • Audit of equipment: • Readily available and maintained equipment the facilitates management of medical emergency • Performance indicators

  22. Performance indicators

  23. Ethics: DNR issue

  24. Conclusion • Clinical Emergency Response System (CERS) • Hospital wide multi-disciplinary • Resuscitation for Cardiorespiratory arrest • Early recognition of Deterioration of conditions likely to lead to cardiorespiratory arrest unless appropriate intervention • For improving morbidity and mortality

  25. Thank You!

  26. Reference

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